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Gone are the days of just visualizing the tube passing through the rope and observing whether the tube is foggy with the help of technology that helps to verify the position of the tube
Sponsored by Bound Tree Medical
Author: Tim Nowak for EMS1 BrandFocus
Are you in the right place? Are you really ventilating your lungs, or are you making chest noises in your stomach? How can you be sure?
Verifying the placement of the endotracheal tube is essential to manage the airway of the intubated patient. In fact, this is critical.
From the first day of your airway management seminar-whether as an EMT or as a caregiver-whenever a supraglottic airway device or endotracheal tube is inserted into the patient's mouth, the rest of the discussion revolves around airway verification The importance of unfolding. We practice the correct technique, discuss troubleshooting, provide countless times of ventilation, washing, flushing and repetition (over and over).
This skill should be able to perform without hesitation with 100% confidence (not 100% ignorance-even worse, 100% arrogance).
Whether you are participating in an initial training program, participating in continuing education courses, completing daily intubation challenges, or entering an intensive care training program, verification of endotracheal intubation placement (and proper training to get you there).
Seeing, listening and feeling... it seems to be very basic. Training related to airway management starts with the basics of watching the catheter pass through the umbilical cord (ie endotracheal tube), listening to the stomach with a stethoscope (first) and then listening to the lungs (auscultation), and then feel—actually put your hands on On the patient’s chest, feel the rise and fall of the chest wall during each ventilation.
In combination with other basic old-school options, such as finding tube fog, using an esophageal tube detector device, or connecting a colorimetric carbon dioxide meter (for many algorithms, this has almost been phased out), starting from the basics is to get your intubation access (or Enter) the right path.
Whether this is your organization’s standard practice or a backup practice, video laryngoscopy must have fully entered the EMS/pre-hospital market.
The important point to be emphasized in the VL training is the use of appropriate tools, techniques, and positioning for each vendor’s equipment. The use of ultra-curved channel blades is different from standard curved non-channel blades. Use the video screen attached to the laryngoscope handle to operate, instead of being separated and located on the patient's side.
In this equation, rigid and flexible probes can also change the rules of the game. Make sure that each provider fully understands everything related to the equipment they use. This is essential to correctly intubate the patient and verify that the tube is in the correct position.
We can spend a whole week discussing and training capnography topics, which include not only end-tidal carbon dioxide-EtCO2-values, but also capnography waveforms.
There is no doubt that capnography verification is regarded as the gold standard for airway equipment placement verification in almost all EMS organizations. However, what is not always emphasized in training is when your capnogram (and EtCO2) does not match the patient's performance, or when the alarm goes off and makes you feel uneasy.
What if something goes wrong? What if my endotracheal tube is no longer in the trachea-what now? Should you pull the tube, ventilate the mask manually and try again? If your tube is indeed in the trachea, how about inserting the probe before extubation to ensure proper replacement?
What other next steps or troubleshooting measures can be taken to train airway placement verification?
Enter the equation ultrasound. It is not only used to evaluate "hot abdomen" (abdominal bleeding) or "marching ants" and "barcodes" (normal vs. pneumothorax mode). Ultrasound can also be used to visualize catheter placement in a patient's trachea or esophagus.
When transporting intubated patients, let your staff enter the transfer between facilities, leave the scene to fly, and even ROSC scenes. In the early days of departure, your EtCO2 alarm starts to sound (low value) and your waveform disappears. The crew checked their connections, auscultated the lungs, observed the bumps in the chest...everything seemed to be fine. However, the alarm still sounded. How can you increase your confidence and certainty to keep your tube in the right position?
Ultrasonic technology-now in the palm of your hand-allows you to "see" where the tube is placed, providing you with the verification you need. It can help you confidently provide you with TRUE (tracheal ultrasonography) results.
We have training. We have tools. We have no excuses, and our continuing education and training should prove this. Furthermore, we need to accurately and thoroughly record our findings, actions, and reassessments of airway management during each call.
Verifying airway placement is a multi-step, multi-tool, and multi-method process. We need to combine our strengths, conduct training in the classroom, and provide appropriate, high-quality clinical care when treating patients behind the ambulance.
For more information about training and airway management equipment, please visit Bound Tree Medical.
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Tim is the founder and CEO of Emergency Medical Solutions, LLC, an EMS training and consulting company he founded in 2010. He has nearly two decades of experience in the emergency services industry, having served as a professional firefighter, paramedic and intensive care paramedic in various urban, suburban, rural and hospital settings. In addition to training content delivery and project development spanning the entire career, his background also includes nearly ten years of experience at the level of company officials and chief officials. He has extensive experience in EMS operations, community nursing staff, quality assurance, data management, training, special operations and management disciplines, and has a certificate in supervising and managing nursing staff.
Tim also has positive experience as a columnist and content developer, with more than 200 published works and more than 100 hours of online educational content, and is a social media influencer on LinkedIn in the EMS industry. Contact him on LinkedIn or at tnowak@emergencymedicalsolutionsllc.com.
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